Apparatus and method for effecting at least one anatomical structure

ABSTRACT

Exemplary embodiments of apparatus and method for effecting at least one anatomical structure of a body can be provided. For example, at least one first arrangement can be provided which is structured to be at least partially inserted into the body and including an opening. In addition, at least one second arrangement can be provided which configured to increase and/or decrease a size of the opening by a motion thereof in a first direction. Further, at least one third arrangement can be provided which can be coupled to the second arrangement(s), and configured to move at least in a second direction which is at least approximately parallel to the second direction. In particular, when the anatomical structure(s) is/are provided or inserted in the opening and is pressed on by the second arrangement(s), a first motion of the second arrangement(s) toward the anatomical structure(s) in the first direction is reduced and/or terminated while a second motion of the third arrangement(s) in the second direction either (i) remains at least approximately the same, and/or (ii) is reduced to a lesser extent than that of the first motion.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims priority from U.S. Patent ProvisionalApplication Ser. No. 61/328,005 filed Apr. 26, 2010, which is hereinincorporated by reference in its entirety.

FIELD OF THE DISCLOSURE

The present disclosure relates to an apparatus and method for effectingat least one anatomical structure, and more particularly to exemplaryembodiments of the apparatus and method to effectuate a surgicaltreatment of tissue masses located inside the human body, e.g., in thehollow internal organs such as the colon. The exemplary apparatus andmethods can be suitable for, e.g., a treatment of hemorrhoids, as wellas other conditions. The exemplary apparatus and method can beimplemented to, e.g., compress a hemorrhoid or/and reduce its bloodsupply with a clamping instrument, while preventing a cutting of thehemorrhoid or its blood vessels with such exemplary instrument.

BACKGROUND INFORMATION

There are a variety of abnormal conditions in the body which can berelated to the wall(s) of hollow organs. Colonic polyps and tumors,endothelial vascular lesions, diverticuli, and symptomatic internalhemorrhoids are some of the examples of these abnormal conditions. Atreatment to such abnormal conditions from inside a hollow organ cavityor a lumen (so-called intra-luminal or endolumenal approach) may bebeneficial to the patient since a surgical access trauma is reduced oreliminated.

One common condition that can be easily treated with the endoluminalapproach is a symptomatic internal hemorrhoids condition. Internalhemorrhoids are conventionally treated using a variety of interventionaland non-interventional endoluminal methods. An immediate proximity ofinternal hemorrhoids to the external orifice allows for a relativelyeasy access thereto. Several technologies for treating the internalhemorrhoids are currently available, but are fairly complex and/orfrequently have less than acceptable clinical outcomes and/or high costsassociated therewith.

Hemorrhoidal disease is a very common condition that can occur in morethan half of the population by the age of 50. Currently, over 10 millionpeople suffer symptoms from hemorrhoids in the United States, and onemillion new cases of symptomatic hemorrhoids are diagnosed annually.Approximately 10-20 percent of such cases may need a surgical removal ofthe hemorrhoid, which is associated with significant postoperativemorbidity and high cost to the individuals and society.

The term “hemorrhoid” is generally used to refer to the disturbingperianal symptoms related to vascular complexes in the lower rectum andanus. This is usually associated with enlargement of this naturallyoccurring vascular tissue, which is responsible for its subsequentbleeding, prolapsing, thrombosis, itching, burning, etc. Repetitivestraining due to constipation appears to be a leading factor in formingand progressing of hemorrhoids. The chances of having symptomatichemorrhoids increase with age, pregnancy, obesity, sedimentary life,heavy lifting and genetic predisposition.

Various treatments can be tailored to the type and severity of thespecific hemorrhoids. A pharmacological treatment, which is aimed at theregulation of defecation and symptomatic relief, may be less beneficialas likely having only a temporary and frequently incomplete effect.Current interventional, non-excisional, therapies are designed toobliterate blood supply to part of or to the entire hemorrhoid (e.g.,rubber band ligation, infrared coagulation, injection sclerotherapy,ultrasound guided hemorrhoidal artery ligation, etc.). These treatmentshave modest, inconsistent clinical success with a frequent recurrencerate.

Rubber band ligation is one popular treatment method of hemorrhoids. Inthe rubber band ligation, some hemorrhoidal tissue is pulled into theligator, and a rubber band is placed around the base of the pulledtissue. This causes a strangulation of the blood supply to a portion ofthe internal hemorrhoid and its overlying rectal mucosa. An ischemicnecrosis and autoamputation of the hemorrhoid can generally follow in afew days, leaving an open rectal wound, which heals over several days.Severe and possibly debilitating postoperative pain is rare, butsignificant anal discomfort and tenesmus (a painfully urgent butineffectual sensation or attempt to defecate) are frequent. Recurrencesafter the rubber band ligation are also frequent. In addition, sincesuch treatment leaves the patient with an open wound in the anus forseveral days, the rubber band ligation may be rendered unsuitable forHIV-positive patients, and may require a demanding preparation forpatients with bleeding disorders.

Sclerotherapy is another method for treatment of small internalhemorrhoids. A sclerosing agent is injected via a needle into and aroundthe internal hemorrhoid. The rates of complications and recurrence ofsclerotherapy can be high.

An ultrasound guided hemorrhoidal artery ligation involves manualsuturing of the rectal tissues containing the hemorrhoial artery. Theartery can be located by ultrasound radiation with an appropriateultrasound arrangement. A resulting regression of the correspondinginternal hemorrhoid would be expected. Since the suture-ligation can beperformed above the internal hemorrhoid in the pain-insensitive zone,the procedure should be painless. However, such technique is demanding,and is highly dependent on the operator's experience and dexterity.Inexperience or lack of skill of the operator is responsible for both“missing” the hemorrhoidal artery and inadvertent rectal and vascularinjuries. Hemorrhoidal artery injuries with resulting severe bleeding,rectal wall injury, etc. have been reported, and the recurrences arefrequent.

The treatment of internal hemorrhoids with infrared coagulation caninvolve a blind heat coagulation of the branches of superiorhemorrhoidal artery. Theoretically, when the branches of superiorhemorrhoidal artery are successfully targeted, it can cause a subsequentregression of the corresponding internal hemorrhoid. However, since theexact location of the artery is not known, there is no guarantee thatthe infrared coagulation pulses reach the vessels and hence have anyeffect on hemorrhoids. Multiple treatments in a time span of severalmonths are currently recommended by the distributor and treatingdoctors. The proper application of the infrared probe can be difficultwith larger hemorrhoids due to obscurity of the interface between theprobe and mucosa. Recurrences and ineffective treatment can be frequent.

Traditional surgical excision of hemorrhoids can be an effective butoften a debilitating form of treatment. The hemorrhoidal tissue can beremoved in longitudinal (parallel to main rectal axis) direction.Surgical excision of hemorrhoids may require the use of an anesthesia,and can cause a severe postoperative pain to the patient for severalweeks along with a significant loss of work time therefor. Suchtechnique is also dependent on the technical skill of the operator.

Another procedure, i.e., a Procedure for Prolapse and Hemorrhoids (PPH)can be used which involves circumferential excision of the rectal mucosaand submucosal layer proximal to the internal hemorrhoids using acircular stapler. As a result, a superior hemorrhoidal blood supply canbe interrupted, while the hemorrhoidal tissue itself is left toischemically regress. Since the excision is performed above the dentateline, a decreased postoperative pain and faster recovery (when comparedto traditional hemorrhoidectomy) would likely occur. The internalhemorrhoids can consequently shrink within four to six weeks after suchprocedure. This PPH technique requires the implementation by highlyskilled operators, as well as a significant learning curve, a general orregional anesthesia, and an expensive instrumental set-up. In addition,the use of PPH creates a substantial circumferential rectal trauma,which is likely excessive in the majority of cases when only 1 or 2hemorrhoids are enlarged. A substantial circumferential injury of theanal canal and subsequent scarring can cause a rectal stricture(narrowing), which is debilitating and difficult to treat in patients.Serious complications during and after PPH have been previouslyreported.

Thus, there are several less invasive procedures than conventionalsurgery methods for the treatment of symptomatic internal hemorrhoids.However, such methods do not have the desired combination of simplicity,effectiveness and being substantially painless, minimally invasive, andinexpensive.

Accordingly, there is a need to provide a device and method whichovercome at least some of the deficiencies with the previous devices andmethods.

SUMMARY OF EXEMPLARY EMBODIMENTS OF THE DISCLOSURE

At least some of the objects of the present invention are to provideexemplary devices and methods to overcome at least some of thedeficiencies indicated hereinabove. For example, the exemplaryembodiment of the method and device may be provided which can be usefulin the treatment of hemorrhoids and/or associated tissues, and canfacilitate a less traumatic experience than the conventional methods anddevices for the treatment of hemorrhoids. The exemplary device andmethod can also be utilized for treatment of other pathologies inlocations remote from body openings.

With one exemplary embodiment of the method and device of the presentdisclosure, it is possible to effectuate an approximately constanttissue compression by a clamp arrangement, which is at least partiallyindependent of the clamp-actuating force applied by a user to theassociated handle of the exemplary device. In the exemplary embodimentsdescribed below in this Summary Section, the first component, first partand first arrangement are used interchangeably, and designated byreference numeral I in the drawings. The second component, second partand second arrangement are used interchangeably, and designated byreference numeral II in the drawings. The third component, third partand third arrangement are used interchangeably, and designated byreference numeral III in the drawings. The first spring in exemplaryembodiments is designated by reference numeral 12 and the second springis designated by reference numeral 13. The first closure member inexemplary embodiments corresponds to the first closure member 9 of partII and the second closure member in exemplary embodiments corresponds tosecond closure member 10 of part III.

According to one exemplary embodiment of the present disclosure, asurgical instrument can be provided which comprises an insertablearrangement having a window 6, and a closure member 10 movably connectedto the insertable arrangement for alternately covering and uncoveringthe window, and applying pressure to or clamping any material providedwithin the window. The insertable arrangement can have a first (e.g.,clamping) surface 7 a along an edge of the window 6, and the closuremember 10 can have a second (e.g., clamping) surface 7 b situatedopposite to the first surface to be able to selectively cover anduncover the window so as to apply a force to or clamp any tissue orobject provided within the window. The exemplary instrument alsoincludes a tissue effecting component coupled to the insertablearrangement and/or the closure member for acting on tissues gripped orclamped between the first surface 7 a and the second surface 7 b. Theexemplary instruments also have a further arrangement which isconfigured to propel the second surface 7 b toward the first surface 7 aso as to apply pressure to or clamp any object or tissue provided in thewindow, and also to prevent further pressure or clamping to be appliedto the object or tissue if the pressure and/or clamping thereon exceedsa particular amount of pressure.

According to a particular exemplary embodiment of the presentdisclosure, the instrument can have a second closure member 10 whichincludes the second clamping surface 7 b and a first closure member 9which is connected to a second handle grip 8. The second handle grip 8can be part of a second arrangement II. The first and second closuremembers can slide in relation to each other, and are connected to oneanother via a spring, referred to herein as the second spring such asspring 13.

In accordance with another embodiment of the present disclosure, thedevice has at least two springs. A first spring 12 is affixed to a firsthandle grip 5 at one end and to the first closure member 9 at anotherend thereof at their fixation points. The first handle grip is part of afirst arrangement I. A second spring 13 is affixed to the first closuremember 9 at one end, and to the second closure member 10 at another endthereof at their respective fixation points. For example, according toone exemplary embodiment of the present disclosure, the springs 12, 13can stretch between the fixation points during the window closure whenthe grip handles of the first and second parts (arrangements) I, II aremoved toward one another. The second spring 13 provides an ability toeffectuate an approximately constant tissue compression function, andavoid an unwanted excessive compression of the tissue. Each of thesprings (e.g., the first spring) can facilitate a return of the closuremember to its non-deployed (open) position so as to maintain the window6 open for another insertion of the tissue or object therein.

In an exemplary operation, when a squeezing force is applied to thehandle, e.g., for the purpose of compressing the tissue between thefirst and second clamping surfaces 7 a, 7 b, a second handle grip of thesecond component II moves towards a first handle grip of the firstcomponent I (proximal in relation to the insertion tip of the device)located distal of the second handle grip. In one exemplary embodiment,this causes the first closure member 9 to move towards the insertion tipof the device, and the second (e.g., clamping) surface 7 b of the secondclosure member 10 moves towards the clamping surface 7 a of the firstcomponent I. As the first closure member 9 moves forward toward theclamping surface 7 a of the first component, the first and secondsprings 12, 13 are pulled in a general direction of the window 6, andare stretched.

The first spring 12 facilitates gliding of the first closure member 9during the closure and helps return the closure member to itsnon-deployed (open) position after the handle is released.

The second proximal spring 13 provides the constant tissue compressionfunction during closure and facilitates returning of the second closuremember 10 to its non-deployed position after the handle is released.

When the first closure member 9 is actuated by squeezing the handle ofthe device and hence the second handle grip and the associated firstclosure member 9 move forward, the second proximal spring 13 (which isconnected between first and second closure members) pulls and movesforward the second closure member 10. If the second closure member 10doesn't meet an obstacle in the window, for example, a protrudingtissue, the second clamping surface 7 b of the second closure membermeets the first clamping surface 7 a of the first component withoutsubstantially stretching the spring 13. The device's parts aredimensioned so that when the first and second handle grips meet, theopposing first and second clamping surfaces 7 a, 7 b touch each otherand the window closes.

If the second closure member 10 meets an obstacle in the window, forexample, a protruding tissue, the second closure member 10 (and secondclamping surface 7 b) stops, while the first closure member 9 continuesits forward movement and slides over the second closure member 10. As aresult, the second spring 13 stretches and an additional (after movementof the second closure member is stopped by the tissue) squeezing forceof the handle by an operator translates into forward movement of thefirst closure member 9 of the second component II and stretching of thesecond proximal spring 13. Consequently, only constant compression tothe tissue is delivered as designed by the strength of the second spring13 and the compressing tissue properties, regardless of the additionalforce used by an operator.

When the handle is released, the first spring 12 pulls back on firstclosure member 9 and its associated second handle grip and brings itback to its non-deployed (open) position.

As the first closure member 9 and its associated second handle grip isreturning to its open position, the first closure member 9 pulls back onthe second closure member 10 and returns it to its non-deployed (open)position. As a result, the window 6 is opened and the tissue isreleased.

In addition, according to one exemplary embodiment of the presentdisclosure, it is possible to provide a device which can be anendoluminal intervention assembly that includes an accessory system forthe delivery and support (e.g., optically and/or mechanically) ofinstrumentation to surgical sites remote from the body openings.

In accordance with yet another exemplary embodiment of the presentdisclosure, apparatus and method for effecting at least one anatomicalstructure of a body can be provided, including at least one firstarrangement I which is structured to be at least partially inserted intothe body and including an opening. In addition, at least one thirdarrangement III can be provided which is configured to increase and/ordecrease a size of the opening by a motion thereof in a first directione.g., a distal direction. Further, at least one second arrangement IIcan be provided which can be coupled to the third arrangement(s) III,and configured to move at least in a distal direction which is at leastapproximately parallel to the first direction. In particular, when theanatomical structure(s) is/are provided or inserted in the opening andis pressed on by the third arrangement(s) III, a first motion of thethird arrangement(s) III toward the anatomical structure(s) in the firstdirection is reduced and/or terminated while a second motion of thesecond arrangement(s) II in the second direction either (i) remains atleast approximately the same, and/or (ii) is reduced to a lesser extentthan that of the first motion.

In addition, at least one tension-setting arrangement can be providedwhich couples the third and second arrangements III, II to one another.The tension-setting arrangement(s) can include at least one spring 13,and when the anatomical structure is pressed by the thirdarrangement(s), a tension of the at least one spring 13 can be increasedwhich causes the third arrangement(s) III to at least reduce the firstmotion in the first direction while facilitating the second motion ofthe second arrangement(s) II to be unreduced or reduced less than thefirst motion. The spring(s) 13 can generate a force on the secondarrangement(s) which can facilitate a gradual constant tissuecompression.

According to yet another exemplary embodiment of the present disclosure,the third arrangement(s) III can comprise a closure arrangement 10 whichis structured to be moved toward and away from a tip portion of thefirst arrangement(s) I, and can include a contacting surface such asclamping surface 7 b which is configured to increase and/or reduce thesize of the opening and contact the anatomical structure(s). The firstarrangement I can include a first handle structure, and the secondarrangement(s) II can include a second handle structure which isconfigured to move toward the first handle structure. In addition, atension-setting arrangement can be provided which couples the first andsecond arrangements to one another and can include a constant forcespring 12 that is attached between the first handle structure and theclosure arrangement such as closure member 9 of the second arrangement.

According to still another exemplary embodiment, when the anatomicalstructure is pressed by the closure arrangement such as closure member10 of the third arrangement III, a motion of the closure arrangement canbe reduced or stopped, and the second arrangement(s) II can slide overthe closure arrangement of the third arrangement III in the firstdirection. Further, when the anatomical structure is pressed by thethird arrangement(s), a tension of the spring 13 is increased whichlikely causes the second arrangement(s) II to at least reduce the firstmotion of the closure arrangement in the first direction and facilitatethe second arrangement to slide over the closure arrangement of thethird arrangement III.

In yet a further exemplary embodiment of the present disclosure, thefirst arrangement(s) I can include a first handle structure and ananascope structure non-releasably connected to one another. A secondarrangement II can also be provided which can include at least onefurther spring arrangement such as spring 12 coupling the first andsecond arrangements I, II, to one another. The first arrangement(s) caninclude at least one handle portion, and the second arrangement(s) cancomprise a first closure arrangement such as closure member 9 which isstructured to be moved toward and away from a tip portion of the firstarrangement I. The further spring arrangement(s) can be coupled to thehandle portion(s) of the first handle structure and the first closurearrangement. The further spring arrangement(s) can facilitate a movementof the closure arrangement in a direction that is at least approximatelyopposite to the first direction. The first direction can be a distaldirection.

According to yet a further exemplary embodiment of the presentdisclosure, the second arrangement(s) can include therein or thereon atleast one electrode provided at or near the contacting surface. Theelectrode can be powered by an electrical power source. Suchelectrode(s) can be at least partially embedded within the firstarrangement(s). The electrode(s) can be configured to irradiate at leastone area of the anatomical structure(s) when the anatomical structure isconstricted in the opening by the second arrangement(s). Further, thesecond arrangement(s) can include therein or thereon at least oneillumination arrangement which provides light to the anatomicalstructure(s).

These and other objects, features and advantages of the exemplaryembodiment of the present disclosure will become apparent upon readingthe following detailed description of the exemplary embodiments of thepresent disclosure, when taken in conjunction with the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

Further objects, features and advantages of the present disclosure willbecome apparent from the following detailed description taken inconjunction with the accompanying figures showing illustrativeembodiments of the present disclosure, in which:

FIG. 1 is a side cross-sectional view of an exemplary embodiment of adevice according to the present disclosure in an open position; FIG. 1Ais a side cross-sectional view of an alternate embodiment of the deviceof the present disclosure in an open position; FIG. 1B is a sidecross-sectional view of another alternate embodiment of the device ofthe present disclosure shown in an open position; and FIG. 1C is a sidecross-sectional view of another alternate embodiment of the device ofthe present disclosure shown in an open position;

FIG. 2 is a side cross-sectional view of the device of FIG. 1 in aclosed position; FIG. 2A is a side cross-sectional view of the device ofFIG. 1 in a fully open position; and FIG. 2B is an exploded view of thedevice of FIG. 1; FIG. 2C is a side cross-sectional view of the deviceof FIG. 1 in a partially closed position wherein the tissue iscompressed by the second closure member; and FIG. 2 d is a sidecross-sectional view similar to FIG. 2 c showing movement of the firstclosure member with respect to the second closure member and tensioningof the spring;

FIG. 3A is a left side cross-sectional view of a first part (component)of the device of FIGS. 1 and 2;

FIG. 3B is a right side cross-sectional view of the first part shown inFIG. 3A;

FIG. 3C is a right side perspective view of the first part shown in FIG.3A;

FIG. 3D is a left side perspective view of the first part shown in FIG.3A;

FIG. 4A is a right side view of a second part (component) of the deviceof FIG. 1;

FIG. 4B is a rear view of the second part shown in FIG. 4A;

FIG. 4C is a right side view of the second part shown in FIG. 4A;

FIG. 4D is a perspective view of the second part shown in FIG. 4A;

FIG. 5A is a side view of a third part (component) of the device of FIG.1;

FIG. 5B is a top view of the third part shown in FIG. 5A;

FIG. 5C is a right side perspective view of the third part shown in FIG.5A;

FIG. 5D is a left side perspective view of the third part shown in FIG.5A;

FIG. 6A is a lateral side view of a spring used in the device of FIG. 1;and

FIG. 6B is a front view of the spring illustrated in FIG. 6A.

Throughout the figures, the same reference numerals and characters,unless otherwise stated, are used to denote like features, elements,components or portions of the illustrated embodiments. Moreover, whilethe subject disclosure will now be described in detail with reference tothe figures, it is done so in connection with the illustrativeembodiments. It is intended that changes and modifications can be madeto the described exemplary embodiments without departing from the truescope and spirit of the subject disclosure as defined by the appendedclaims.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS

FIGS. 1-6B show various components of an exemplary embodiment of adevice according to the present disclosure. As shown in these drawings,the exemplary device has three primary parts, e.g., a first part orcomponent (or member) I, a second part or component (or member) II and athird part or component (or member) III. The first part I (as shown in,e.g., FIGS. 1-3D) comprises a hollow portion 1 which includes a taperedend or insertion tip 16 which is structured or configured for insertioninto or propagation through a bodily lumen or another anatomicalstructure, a first handle grip 5 (which is proximal (closer to the user)with respect to the tip 16) and a connecting section 4. The second partII (as shown in, e.g., FIGS. 1, 2, 2A, 2B and 4A-4D) comprises a secondhandle grip 8 (which is proximal with respect to the tip 16) and a firstclosure member 9, which can be non-releasibly connected. The third partIII (as shown in, e.g., FIGS. 1, 2, 2A, 2B and 5A-5D) comprises a secondclosure member 10. The exemplary device provides a handle 2 (FIG. 1)which comprises the first handle grip 5 of the first part I and thesecond handle grip 8 of the second part II.

Referring to FIGS. 1, 2, 2A, 2B, 6A and 6B, the exemplary device has afirst spring 12 and a second spring 13, whereas the first spring 12 canbe provided closer to the tip 16 than the second spring 13, and both ofwhich can have two or more fixation points. Thus, the second spring 13can be provided more proximal than the first spring 12. The first spring12 can include (i) a first fixation point 12 a provided at or on thefirst handle grip 5 of the first part I (as also shown in FIGS. 3A and3C) and (ii) a second fixation point 14 (as also shown in FIGS. 2B, 4A,4C and 4D) located on and below a surface of the first closure member 9of the second part II. The second spring 13 also has (i) a firstfixation point 13 a located on or at the second closure member 10 ofthird part III (as also shown in FIGS. 5B and 5C), and (ii) a secondfixation point 15 located on and below the surface of the first closuremember 9 of second part II (as also shown in FIG. 4D).

When the exemplary device is assembled, the second spring 13 is providedor positioned just below a particular surface 20 of the second closuremember 10, while also being coupled to the first fixation point 13 athereof. Any of the fixation points 12 a, 13 a, 14 and/or 15 can bemetal and/or plastic knob(s) or other members to which the respectivefirst and second springs 12, 13 can be attached, clipped unto and/oradhered to, e.g., possibly with glue, clips, etc. The exemplary detailsof the first and second springs 12, 13 are illustrated in FIGS. 6A and6B. However, it should be understood that other shapes and/or or sizesof the springs are conceivable and are within the scope of the exemplaryembodiments of the present disclosure.

FIGS. 1, 2, 2A and 2B show that the first spring 12 couples the firstpart I and the second part II to one another. These drawings alsoillustrate that the second spring 13 couples the first and secondclosure members 9, 10 of respective parts II and III to one another,which are slidably engaged with each other.

As shown in FIGS. 1 and 2, the exemplary device includes a window 6which is enclosed between and formed by at least two opposing clampingsurfaces, e.g., a first opposing clamping surface 7 a (which is part ofthe hollow portion 1 of the first part I), and a second opposingclamping surface 7 b (which is part of the second closure member 10 ofthe third part III and provided on the edge thereof). The secondclamping surface 7 b is moved toward the first clamping surface 7 a bymoving the third part III toward the first clamping surface 7 a to closeor reduce the size of the window 6 and away from such first clampingsurface 7 a to open or increase the size of the window 6. Such movementof the third part III can be actuated by squeezing and/or releasing thehandle 2 of the exemplary device.

For example, according to one exemplary embodiment of the presentdisclosure, when the second handle grip 8 is moved toward the firsthandle grip 5 by squeezing (see arrow of FIG. 2), during such exemplarysqueezing motion by the operator's hand, the window 6 size is reduced,by, e.g., being closed until it meets an obstacle, such as, for example,a protruding tissue 17 (as shown in FIG. 1). In addition, the window 6is intended to be closed when the first and second opposing clampingsurfaces 7 a, 7 b meet each other (as shown in FIG. 2). Thus, the window6 becomes bigger when the second closure member 10 moves away from thefirst opposing clamping surface 7 a of the first part I, and smallerwhen the second closure member 10 moves towards the first opposingclamping surface 7 a of the first part I.

In an exemplary operation, when the second handle grip 8 of the secondpart II. is moved toward the first handle grip 5 of the first part I(see FIG. 2), for example, during a squeezing motion by the hand of theoperator, the second part II pulls on the second spring 13. This isbecause the second spring 13 is connected at one end thereof to thesecond part II via the second fixation point 15 (as shown in FIGS. 2A,2B and 4D) which is located on and below a surface of the first closuremember 9 of the second part II. The strength of the second spring 13 isselected or configured so as to facilitate the second main part II topull the second closure member 10 of the third part III in the samedirection as the direction of propagation of the first closure member 9.Indeed, during the exemplary operation, the second closure member 10 ofthe third part III is moved by the first closure member 9 of the secondpart II forward toward the first clamping surface 7 a by pulling (e.g.,likely without significant stretching) the second spring 13, providedthat the second closure member 10 does not meet the obstacle in thewindow 6. Indeed, such pulling motion is effectuated since another endof the second spring 13 is connected to the first fixation point 13 alocated on or at the second closure member 10 and below the particularsurface 20 thereof (as also shown in FIGS. 5B and 5C). Thus, the secondspring 13 acts as a spring coupling arrangement between the second partII and the third part III.

As shown in FIG. 1, if the second closure member 10 of the third partIII meets the obstacle in the window 6 (e.g., the protruding tissue),the forward motion of the second closure member 10 in the same directionas that of the second part II stops completely or for the most part asshown in FIG. 2C. At the same time, the second part II of the exemplarydevice continues to move forward in the same direction, and also(simultaneously) causes the second spring 13 to stretch as shown in FIG.2D. As a result, the first closure member 9 of second part II slidesover the second closure member 10 of the third part III towards thefirst clamping surface 7 a or the end or tip 16, without furtheraffecting the forward movement of the second closure member 10 of thethird part III and absent any further significant compression of thetissue situated within the window 6 (see FIG. 2D).

This exemplary effect is caused by the fact that when the secondopposing clamping surface 7 b of the second closure member 10 of thethird part III contacts and attempts to press on the tissue providedwithin the window 6, this negative pressure causes the second spring 13to stretch. In this manner, while the second closure member 10 of thethird part III is prevented from moving forward by the tissue, a tensionis continued on the second spring 13, allowing the first closure member9 of the second part II to continue its forward motion toward the tip16. Such tension on the second spring 13 facilitates an approximatelyconstant compression on the tissue. Indeed, as a result, a constanttissue compression (e.g., on the tissue or on any other object) can beaccomplished in the window 6. Such constant tension or compression canbe largely separate from or independent of the force exerted by theoperator on the handle 2, for example, the compression of the tissue canbe mainly dependent upon various properties of the second spring 13, theconnections thereof to the second and third parts II, III, and theproperties of the compressed tissue 17 in the window 6.

In addition, according to another exemplary embodiment of the presentdisclosure, the first spring 12 can be useful in facilitating theoperation of the exemplary device. For example, when the second handlegrip 8 of part II is moved toward the first handle grip 5 of part I (seearrow of FIG. 2), e.g., during the squeezing motion by the hand of theoperator, the second part II is simultaneously pulled on and stretchesthe first spring 12 (as shown in FIG. 2). This is because one end of thefirst spring 12 is coupled to the second fixation point 14 (as shown inFIGS. 2B, 4A, 4C and 4D) located on and below the surface of the firstclosure member 9 of the second part II, and the other end of the firstspring 12 is coupled to the first fixation point 12 a provided at or onthe first handle grip 5 of the first part I (as shown in FIGS. 3A and3C). In this manner, the first spring 12 is stretched by the forwardmovement of the first closure member 9 of the second part II toward thefirst clamping surface 7 a or the end or tip 16 of the first part I,while the first part I is stationary with respect to the tip 16.

During the exemplary operation, and referring to FIGS. 1 and 2A, whenthe squeezed handle 2 is released, the first spring 12 has the tensionto cause itself to return to its original (e.g., non-stretched orless-stretch) configuration, thereby pulling on the first closure member9 of the second part II until the second part II returns proximally toits non-deployed (e.g., open or original) position. Again, this iscaused by the first spring 12 being attached to a stationary first partI via the first fixation point 12 a, and pulling the first closuremember 9 of the second part II back to its original position due to thefirst spring 12 being connected to the second fixation point 14 of thefirst closure member 9. In addition, as the second part II is in theprocess of returning to its non-deployed position (shown in FIG. 2A)with the assistance of the first spring 12, the second part II alsopulls on and effectuates further tension of the second spring 13, whichpulls back the second closure member 10 due to its coupling to the firstfixation point 13 a thereof until the second closure member 10 returnsto its non-deployed position. When the second closure member 10 movesback to such position, the window 6 becomes enlarged, e.g., until it isfully open (as shown in FIG. 2A).

FIGS. 1A and 1B illustrate an electrode provided at or near thecontacting surface as referenced above. The electrode 20 in FIG. 1A isshown embedded in the first part I. In the alternate embodiment of FIG.1B, the electrode 22 is provided on second part II near the contactingsurface of the clamping surface. FIG. 1C illustrates an illuminationarrangement 24 on the second part II to provide light to the anatomicalstructure.

It will further be appreciated by those having ordinary skill in the artthat, in general, terms used herein, and especially in the appendedclaims, are generally intended as open. In addition, to the extent thatthe prior art knowledge has not been explicitly incorporated byreference herein above, it is explicitly being incorporated herein inits entirety. All publications referenced above are incorporated hereinby reference in their entireties. In the event of a conflict between theteachings of the application and those of the incorporated documents,the teachings of the application shall control. Various exemplaryembodiments described herein can be used together, in combination and/orseparately from one another in accordance with further exemplaryembodiments of the present disclosure

What is claimed is:
 1. An apparatus for effecting at least oneanatomical structure of a body, comprising: at least one firstarrangement which is structured to be at least partially inserted intothe body and including an opening; at least one second arrangementoperatively connected to the first arrangement; at least one thirdarrangement which is coupled to the at least one second arrangement, theat least one third arrangement movable to at least one of increase ordecrease a size of the opening by a motion thereof in a first direction;and a tension-setting arrangement coupling the second and thirdarrangements to one another to effect movement; the second arrangementmovable parallel to the first direction, wherein, during use of theapparatus to treat tissue when the at least one anatomical structure isprovided in the opening and is pressed on by movement of the at leastone third arrangement to decrease the size of the opening, a firstmotion of the at least one third arrangement toward the at least oneanatomical structure in the first direction is at least one of reducedor terminated while a second subsequent motion of the at least onesecond arrangement at least one of (i) remains at least the same, or(ii) is reduced to a lesser extent than that of the first motion, thesecond arrangement remaining coupled to the third arrangement during thesubsequent second motion, and the tension-setting arrangementmaintaining the coupling of the second and third arrangements during thesubsequent second motion.
 2. The apparatus according to claim 1, whereinthe tension-setting arrangement includes at least one spring whichgenerates a force on the at least one third arrangement whichfacilitates a gradual constant tissue compression.
 3. The apparatusaccording to claim 1, wherein the at least one third arrangementcomprises a closure arrangement having a clamping surface which is movedtoward and away from a tip portion of the at least one first arrangementwhen the third arrangement is moved, the clamping surface includes acontacting surface which is configured to contact the at least oneanatomical structure.
 4. The apparatus according to claim 3, wherein theat least one first arrangement includes a first handle structure, andwherein the at least one second arrangement includes a second handlestructure which is configured to move toward the first handle structure.5. The apparatus according to claim 4, further comprising atension-setting arrangement which couples the first and secondarrangements to one another and includes at least one spring, andwherein the at least one spring is a constant force spring that isattached between the first handle structure and a closure arrangement ofthe second arrangement.
 6. The apparatus according to claim 3, wherein,when the at least one anatomical structure is pressed by the closurearrangement by actuation of a handle and the motion of the closurearrangement of the at least one third arrangement is at least one ofreduced or stopped, continued actuation of the handle causes the atleast one second arrangement to slide over the closure arrangement ofthe third arrangement in the first direction.
 7. The apparatus accordingto claim 6, wherein the tension-setting arrangement which couples thesecond and third arrangements to one another includes at least onespring, wherein, when the at least one anatomical structure is pressedby the at least one third arrangement, a tension of the at least onespring is increased which causes the at least one third arrangement toat least reduce the first motion of the closure arrangement in the firstdirection and facilitates the at least one second arrangement to slideover the closure arrangement.
 8. The apparatus according to claim 3,wherein the at least one second arrangement includes therein or thereonat least one electrode provided at or near contacting surface, the atleast one electrode being powered by an electrical power source.
 9. Theapparatus according to claim 8, wherein the at least one electrode isconfigured to irradiate at least one area of the at least one anatomicalstructure when the at least one anatomical structure is constricted inthe opening by the at least one third arrangement.
 10. The apparatusaccording to claim 8, wherein the at least one second arrangementincludes therein or thereon at least one illumination arrangement whichprovides light to the at least one anatomical structure.
 11. Theapparatus according to claim 3, further comprising at least oneelectrode, wherein the at least one electrode is at least partiallyembedded within the at least one first arrangement.
 12. The apparatusaccording to claim 1, wherein the at least one first arrangementincludes a first handle structure and an anascope structurenon-releasably connected to one another.
 13. The apparatus according toclaim 1, further comprising at least coupling the first and secondarrangements to one another by a spring.
 14. The apparatus according toclaim 13, wherein the at least one first arrangement includes at leastone handle portion, and the at least one third arrangement comprises aclosure arrangement which is structured to be moved toward and away froma tip portion of the at least one first arrangement, and wherein thespring is coupled to the at least one handle portion and the secondarrangement.
 15. The apparatus according to claim 14, wherein the springfacilitates a movement of the closure arrangement in a direction that isopposite to the first direction.